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SATO R, SONODA M, MATSUO R, TAKADA R, KANDA I, SATOH H, FUKE N, YAMADA K, HIRAI T. Surgical management of a dermoid cyst with mandibular gland tissue in a Japanese Black calf. J Vet Med Sci 2023; 85:1110-1115. [PMID: 37648457 PMCID: PMC10600543 DOI: 10.1292/jvms.23-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
A 131-day-old male Japanese Black calf presented with a swollen right cheek from birth. Imaging examination revealed a cyst under the right buccal area and debris-containing fluid inside the cyst, and puncture aspiration revealed a mildly cloudy fluid containing hair and tissue fragments. Histological examination of the excised cyst revealed stratified squamous epithelium with skin appendages in the cyst wall, which was diagnosed as a dermoid cyst. In addition, some submandibular gland tissue was found within the cyst wall. After removal of the cyst, there was swelling in the same area, which resolved with steroid administration. Surgical treatment of buccal dermoid cysts should be performed with caution to avoid damage to adjacent salivary gland tissue.
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Affiliation(s)
- Reiichiro SATO
- Graduate School of Medicine and Veterinary Medicine,
University of Miyazaki, Miyazaki, Japan
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
| | - Misaki SONODA
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
| | - Ringo MATSUO
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
| | - Ren TAKADA
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
| | - Isamu KANDA
- Miyazaki Agricultural Mutual Aid Association, Miyazaki,
Japan
| | - Hiroyuki SATOH
- Graduate School of Medicine and Veterinary Medicine,
University of Miyazaki, Miyazaki, Japan
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
| | - Naoyuki FUKE
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
| | - Kazutaka YAMADA
- School of Veterinary Medicine, Azabu University, Kanagawa,
Japan
| | - Takuya HIRAI
- Graduate School of Medicine and Veterinary Medicine,
University of Miyazaki, Miyazaki, Japan
- Faculty of Agriculture, University of Miyazaki, Miyazaki,
Japan
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2
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Buncke MJ, Lilly GL, Hamilton BE, MacArthur CJ. When is pre-operative imaging required for craniofacial dermoid cysts/sinuses? A review. Int J Pediatr Otorhinolaryngol 2022; 155:111090. [PMID: 35217269 DOI: 10.1016/j.ijporl.2022.111090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dermoid cysts/sinuses (DCS) are congenital masses occurring along lines of embryonic fusion. Midline DCS carry a risk of intracranial extension. Pre-operative computed tomography (CT) or magnetic resonance imaging (MRI) are the primary imaging modalities used and based on the results, the need to involve a neurosurgical team in the resection is determined. Although less so, non-midline locations are also at risk for intracranial communication. This study aims to quantify our institutional experience with both midline and lateral DCS for intracranial extension and discuss potential need for preoperative imaging in all DCS cases. METHODS Institutional Review Board approval was obtained. Pediatric patients ages 0-18 years with DCS presenting to the pediatric otolaryngology, plastic surgery, and neurosurgery clinics from 2005 to 2020 were retrospectively reviewed. Data collected included patient demographics, imaging modality, location, size, complications, and presence/absence of intracranial extension. DCS location included nasoethmoidal (NE), periorbital, frontotemporal (FT), and scalp. Lesions were further classified as midline and non-midline. RESULTS 205 patients with surgically removed DCS were included for analysis. Mean age at surgery was 3 years. MRI was the most common imaging modality used (60.5%), followed by US (18%), CT (18%) and plain films (1%). Locations were: NE (69, 34%), periorbital (67, 33%), FT (28, 14%), and scalp (41, 20%). 105 DCS were midline: NE (69), periorbital (7), and scalp (29). Of these, 29 (28%) had intracranial extension: NE (8), scalp (21). 100 DCS were non-midline: periorbital (60), FT (28) and scalp (12). Of these, 7 (7%) had intracranial extension: periorbital (3), FT (3) and scalp (1). CONCLUSION The risk of intracranial extension of midline craniofacial DCS is well established. We have shown that there is a percentage of lateral DCS which carry a risk for intracranial extension, and for which the involvement of a neurosurgical team may be required. Given the potential benefit, pre-operative imaging of all lateral head and neck DCS may be prudent to screen for intracranial extension.
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Affiliation(s)
- Michelle J Buncke
- Oregon Health & Science University, School of Medicine, United States
| | - Gabriela L Lilly
- Oregon Health & Science University, Department of Otolaryngology, Head & Neck Surgery, United States
| | - Bronwyn E Hamilton
- Oregon Health & Science University, Department of Radiology, United States
| | - Carol J MacArthur
- Oregon Health & Science University, Department of Otolaryngology, Head & Neck Surgery, United States.
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Hong S, Maruyama K, Hatanaka R, Noguchi A, Shimoyamada H, Nagane M, Shiokawa Y. Frontotemporal dermoid cyst with incomplete dermal sinus tract in an adult: A case report. Surg Neurol Int 2020; 11:429. [PMID: 33365191 PMCID: PMC7749934 DOI: 10.25259/sni_504_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Background Non-midline supratentorial dermoid cyst with dermal sinus tract has been rarely reported especially in adults. We recently experienced a noteworthy patient with frontotemporal dermoid cyst with incomplete dermal sinus tract. Case Description A 43-year-old female presented with recurrent subcutaneous mass in the left superolateral orbital region. She had a history of active bronchial asthma, which precluded her from contrast-enhanced imaging studies. Plain imaging studies showed a subcutaneous mass which was continuous with an intrasylvian fissure mass by a tract in the sphenoid ridge and the lesser wing of the sphenoid bone. Frontotemporal craniotomy was performed to reset the mass and the tract. Intraoperative finding showed no intradural tumor components. Extradural component was carefully removed focusing attention on the frontal branch of the facial nerve. The pathology was consistent with dermoid cyst and dermal sinus tract. Postoperatively, she had mild facial palsy of the corrugator supercilii (House and Brackmann Grade II). She was discharged home with modified Rankin scale 1. Conclusion Dermoid cyst needs to be included in the differential diagnosis of adult-onset subcutaneous mass in the frontotemporal regions. After thorough imaging studies for the presence and extent of the sinus tract, the symptomatic lesion should be excised completely once and for all.
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Affiliation(s)
- Sukwoo Hong
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Ryo Hatanaka
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Akio Noguchi
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | | | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan
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Saxena NA, Nair AG, Kulkarni BK, Multani PM, Lahoti HN, Borwankar SS, Goel D. Congenital Dermal Facial Temporal Sinus: Rare Presentation of Intraorbital Dermoid in Children. J Indian Assoc Pediatr Surg 2019; 24:300-302. [PMID: 31571766 PMCID: PMC6752063 DOI: 10.4103/jiaps.jiaps_153_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a rare case of an intraorbital dermoid which was associated with a small temporal region dermal sinus in a 3-year-old child. This got infected and the child presented with orbital cellulitis. Definitive surgery involved excision of all the dermal elements using a superficial and intraorbital approach. We stress the need to evaluate, apparently benign lateral facial dermal sinuses as they may be the pointers of the underlying pathological deep dermoid cysts to avoid complications.
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Affiliation(s)
- Nandita A Saxena
- Department of Pediatric Surgery, Dr. D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Akshay G Nair
- Department of Ophthalmology, Advanced Eye Hospital and Institute, Navi Mumbai, Maharashtra, India
| | - Bharati K Kulkarni
- Department of Pediatric Surgery, Dr. D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Pooja M Multani
- Department of Pediatric Surgery, Dr. D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Hemant N Lahoti
- Department of Pediatric Surgery, Dr. D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Shyam S Borwankar
- Department of Pediatric Surgery, Dr. D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India
| | - Dipesh Goel
- Department of Pediatric Surgery, Dr. D.Y. Patil Hospital, Navi Mumbai, Maharashtra, India
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Yamawaki Y, Horio O, Nomura T, Matsuda S, Nagai M. A dermoid cyst with a draining sinus in the lateral orbital region. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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6
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Frontotemporal Dermal Sinus Tract with 2 Connected Intradiploic Dermoid Cysts: A Rare Case and Review of the Literature. World Neurosurg 2019; 127:350-353. [PMID: 30930322 DOI: 10.1016/j.wneu.2019.03.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Frontotemporal dermal sinus tracts with associated dermoid cysts are very rare, with only 1 found in the largest series to date and 10 total documented case reports. CASE DESCRIPTION We present the first case to our knowledge of a dermal sinus tract associated with 2 intradiploic dermoid cysts in the rare location of the pterion and sphenosquamosal suture. The patient was a 15-month-old girl presenting with periorbital cellulitis who was found to have 2 connected intradiploic cysts on radiographic imaging. The mass was excised, and pathology was consistent with a ruptured dermoid cyst. CONCLUSIONS We review of the literature and argue for early identification and prophylactic surgical resection to avoid complications associated with infection and to mitigate risk of subtotal resection.
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7
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Orbital dermoid cyst presenting as chronic osteomyelitis. J AAPOS 2018; 22:480-481.e1. [PMID: 30144587 DOI: 10.1016/j.jaapos.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/25/2018] [Accepted: 04/29/2018] [Indexed: 11/21/2022]
Abstract
A dermoid cyst is a choristoma that arises from the displacement of ectoderm to a subcutaneous location along embryonic closure lines. Rarely dermoids have a deep intraorbital component that is connected to a superficial component through a defect in bone, also known as dumbbell dermoid. We report the case of a young boy who was misdiagnosed having chronic osteomyelitis of the zygoma, based on the clinical and radiological features. On surgical exploration he was found to have a dumbbell-shaped dermoid with a bony defect. Histopathological features were consistent with a diagnosis of dermoid cyst with chronic inflammation.
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8
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Abstract
Because frontotemporal dermoid cysts are superficial masses on the zygomaticofrontal suture, they are usually removed by simple direct excision in pediatric patients. Adult patients, however, require a more involved treatment approach because these cysts may be large and extend deeply into the surrounding tissue. From 2008 to 2015, 33 adult patients with frontotemporal dermoid cysts were treated in our clinic under a new treatment algorithm. Patients with a cyst smaller than 2 cm in diameter were treated using a direct excisional approach without a preoperative computed tomography (CT) evaluation. Patients with a cyst larger than 2 cm in diameter underwent a preoperative CT evaluation to determine the exact location of the cyst. If the cyst invaded the temporal fossa, a hemicoronal approach was used for excision. Cysts that did not cross the lateral orbital rim were removed using a direct excisional approach. Among the 33 patients in the study, 6 patients had cysts smaller than 2 cm in diameter, and 27 patients had cysts larger than 2 cm in diameter. Of the 27 patients with large dermoid cysts, 17 cysts showed temporal fossa invasion and 10 showed no signs of temporal fossa invasion. In all cases, the cyst was completely excised without rupture, and no instances of complications or recurrence were observed. In adults with frontotemporal dermoid cysts larger than 2 cm in diameter, preoperative CT evaluations should be performed. If the evidence suggests that a cyst has invaded the temporal fossa, a hemicoronal approach is required for complete excision.
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9
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Wagh VK, Lam KC, Morley AMS. Orbital dermoid masquerading as allergic lid swelling. Can J Ophthalmol 2016; 51:e143-e147. [PMID: 27769338 DOI: 10.1016/j.jcjo.2016.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/25/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Vijay Kumar Wagh
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ki Crystal Lam
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - A M Susana Morley
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Bliss M, Grant G, Tittler E, Loven T, Yeom KW, Sidell D. Diagnosis and treatment of pediatric frontotemporal pits: report of 2 cases. J Neurosurg Pediatr 2016; 18:471-474. [PMID: 27391653 DOI: 10.3171/2016.5.peds1687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In contrast to more common nasal and cervical lesions, the frontotemporal pit is a rarely encountered lesion that is often associated with a dermoid and may track intracranially. Due to delays in diagnosis, the propensity to spread intracranially, and the risk of infection, awareness of these lesions and appropriate diagnosis and management are important. The authors present 2 cases of frontotemporal pits from a single institution. Epidemiology, presentation, and management recommendations are discussed.
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Affiliation(s)
- Morgan Bliss
- Departments of 1 Otolaryngology-Head and Neck Surgery
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11
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Quiste dermoide con defecto óseo en apófisis cigomática del frontal. Reporte de un caso. REVISTA MEXICANA DE OFTALMOLOGÍA 2016. [DOI: 10.1016/j.mexoft.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Perazzi A, Berlanda M, Bucci M, Ferro S, Rasotto R, Busetto R, Iacopetti I. Multiple dermoid sinuses of type Vb and IIIb on the head of a Saint Bernard dog. Acta Vet Scand 2013; 55:62. [PMID: 24006855 PMCID: PMC3846701 DOI: 10.1186/1751-0147-55-62] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/22/2013] [Indexed: 11/21/2022] Open
Abstract
Dermoid sinus, a congenital malformation of neural tube development, has been reported in humans and several animal species including dogs. It is typically found in the dorsal midline and commonly occurs in the Rhodesian Ridgeback breed. A case of multiple dermoid sinuses in the fronto-occipital region is described. An 11-month-old, intact female Saint Bernard dog was presented with a 2 day history of discharge from a large irregular subcutaneous mass in the fronto-occipital region. The dog was otherwise healthy. The dog had two circular skin lesions (approximately 4 × 4 and 4 × 2 cm diameter) surrounded by multiple irregular elevated masses. The masses had multiple small openings on the skin surface with tufts of hair protruding from the apertures. The masses were surgically removed, and the diagnosis of multiple dermoid sinuses was confirmed by histological examination. Histopathological examination showed multiple, variably sized, spherical to tubular cysts expanding the dermis and subcutis. Cysts were filled with hair shafts and lamellar keratin and were lined by a stratified squamous epithelium. Sebaceous and apocrine gland adnexal structures were also observed. To the best of our knowledge, this is the first reported case of multiple dermoid sinuses of two different types in the head of a Saint Bernard dog.
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Affiliation(s)
- Anna Perazzi
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Michele Berlanda
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Massimo Bucci
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Silvia Ferro
- Department of Comparative Biomedicine and Food Science, University of Padova, Padova, Italy
| | - Roberta Rasotto
- Department of Comparative Biomedicine and Food Science, University of Padova, Padova, Italy
| | - Roberto Busetto
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | - Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
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Abstract
Dermoid cysts are embryonic lesions usually observed in the lateral eyebrow region and the midline nose and neck areas. Communication of these lesions with the central nervous system is rare and occurs in the nasal region. There are few clinical reports of temporal dermoid cysts presenting with intracranial extension, and we present a 15-year-old girl with a fronto-orbital dermoid cyst with intracranial extension and bone erosion. Her presenting symptom was a lacrimation reduction of the left eye. Excision of the cyst was done using a coronal approach because of its extension and localization.
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14
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Vega RA, Hidlay DT, Tye GW, Fuller CE, Rhodes JL. Intradiploic dermoid cyst of the lateral frontotemporal skull: case report and review of the literature. Pediatr Neurosurg 2013; 49:232-5. [PMID: 25012262 DOI: 10.1159/000363329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/27/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intradiploic dermoid cysts represent 0.04-0.7% of cranial tumors. Fewer than 20 cases of dermoid cysts occurring in the lateral frontotemporal region with a sinus tract and bony involvement are described, only 7 with intracranial extension. We present the first report of such a lesion arising within the lateral coronal suture. As the literature on this topic grows, the matter of preoperative imaging for soft tissue and bony lesions of the lateral frontotemporal region is evolving, and this report offers a preliminary set of criteria for when imaging is a necessity. CASE REPORT A 2-year-old male presented with a bony lesion in the right frontotemporal region. Since birth the lesion had grown commensurately with the patient. Examination revealed an immobile hard mass overlying the right coronal suture with no discernable abnormality. Computed tomography demonstrated a cystic lesion without evidence of intracranial extension. Intraoperatively, the exophytic lesion was fully enclosed by bony matrix, interrupting the coronal suture as it approached the pterion. Following resection, pathology revealed an intradiploic dermoid cyst. CONCLUSION Intradiploic dermoid cysts occurring within patent cranial sutures away from the midline are rarely described lesions. Complete surgical resection with careful follow-up is the treatment of choice.
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Affiliation(s)
- Rafael A Vega
- Department of Neurosurgery, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Va., USA
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15
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Barnard AR, Jones AP, Hodgkinson PD, Jenkins AJ. Beware frontotemporal dermoids - they may have intracranial extension: a case of a middle cranial fossa cyst. J Plast Reconstr Aesthet Surg 2012; 65:e185-8. [PMID: 22370605 DOI: 10.1016/j.bjps.2012.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 11/27/2011] [Accepted: 02/04/2012] [Indexed: 11/17/2022]
Abstract
Congenital orbitofacial dermoid cysts are epithelial lined structures of ectodermal origin that may be associated with sinus tracts and variable deep extension. Midline lesions may extend intracranially, while lateral lesions are thought never to do so. Consequently only midline lesions are usually imaged prior to surgery. We describe a lateral dermoid sinus communicating with an intracerebral dermoid cyst within the middle cranial fossa in a 3 year-old with recurrent periorbital cellulitis and intermittent discharge from a small pimple in the temporal region. This case demonstrates that some lateral "dermoids" need to be treated with more caution if there are unusual features such as dimpling, discharge of material or recurrent wider infection, and preoperative imaging should be carried out to exclude intracranial extension.
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Affiliation(s)
- A R Barnard
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-Upon-Tyne, England, UK
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16
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Naderi S, Nejat F, Shahjouei S, El Khashab M. Cranial dermal sinus: presentation, complications and management. Pediatr Neurosurg 2012; 48:86-92. [PMID: 23037454 DOI: 10.1159/000342681] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/07/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cranial dermal sinus is a very rare anomaly mostly found in the midline occipital area, presenting with diverse clinical features from asymptomatic dermal sinus to symptomatic situations including meningitis, dermoid tumor or abscess. METHODS Medical records of 18 patients with 19 cranial dermal sinuses operated at the Children's Hospital Medical Center in Tehran from 1999 to 2011 were retrospectively studied. Their presentations, accompanying anomalies, radiological and surgical findings were evaluated. RESULTS Patients were aged 1 month to 6 years and were followed for 2-12 years. Most sinuses were located in the midline occipital region. Infection was the most common reason for referral (50%) followed by skin dimple (33.3%). Creamy white discharge was found in 50% of patients. Posterior fossa abscess, hydrocephalus and meningitis were observed in 38.9, 38.9 and 22.2% of children, respectively. All sinus tracts with associated dermoid tumors or abscesses were removed en bloc to decrease the risk of recurrence. CONCLUSION The sinus tracts are a portal of entry for pathogens which result in serious complications of meningitis or abscess. In this series, 67% of children presented with serious symptoms; therefore, we recommend prophylactic surgery in all cranial dermal sinuses. The exact time of surgery is not obvious as the natural course of the disease is unknown. If any symptom is observed surgery should be done as soon as possible. For asymptomatic sinuses identified by the pediatrician during a regular visit prophylactic surgery is recommended as soon as the child can tolerate operation.
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Affiliation(s)
- Soheil Naderi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14155-7854, Iran
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17
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Tien AM, Tien DR. Orbital Dermoid Cyst Presenting with a Discharging Sinus Tract. J Pediatr Ophthalmol Strabismus 2009. [PMID: 19645375 DOI: 10.3928/01913913-20090616-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 11/05/2008] [Indexed: 11/20/2022]
Abstract
This report describes a case of orbital dermoid cyst presenting with a discharging sinus tract. The embryologic basis for orbital dermoids in general is discussed, as well as their typical presentation and management. In the current case, patient presentation and management were somewhat different because of signs of infection and a communicating sinus tract, both highly unusual for orbital dermoids. However, after complete excision of the dermoid and sinus tract, the patient showed complete recovery.
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Riebel T, David S, Thomale UW. Calvarial dermoids and epidermoids in infants and children: sonographic spectrum and follow-up. Childs Nerv Syst 2008; 24:1327-32. [PMID: 18560839 DOI: 10.1007/s00381-008-0660-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 04/23/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Dermoids and epidermoids are defined as ectodermal inclusion cysts. The aim of this study was to evaluate the spontaneous natural behavior and the ultrasonographic appearance of calvarial dermoids and epidermoids. MATERIALS AND METHODS The ultrasonographic image datasets of 100 consecutive children up to 4 years of age (52 females, 48 males; age range at first examination 1 week to 40 months, mean age 8.3 +/- 6.9 months) presenting with a firm palpable calvarial mass (103 lesions) were studied retrospectively. All ultrasound (US) examinations were performed using a 7- to 10-MHz linear transducer including B-mode and color Doppler sonography. US follow-up studies (up to 47 months) could be achieved in 30 patients with 33 lesions. RESULTS At first presentation, all 103 lesions demonstrated very similar US features: a round or oval configuration (diameter 3-18 mm), hypoechogenic, and homogeneous internal structures with a marked hyperechogenic superficial capsule, which were localized adjacent to or expanded into the osseous external calvarial table. No conspicuous flow signs on color Doppler were seen. In 33 lesions with US follow-up investigations, 49% showed variable signs of regression: reduction of size, increase of internal echogenicity, and decrease of demarcation. Eight lesions (24%) remained unchanged. A slight progression up to a maximum diameter of 17 mm but without any increase in osseous destruction was observed in the remainder (27%). There was no lesion with a complete destruction of the underlying bone and no intracranial extension in any of the cases. CONCLUSIONS Calvarial dermoids and epidermoids in infants and children show a benign natural behavior with spontaneous regression in a large number of cases. On US, they demonstrate uniform pathognomonic features enabling the correct diagnosis in any of those lesions. Thus, additional, mainly radiation burdening and sometimes misleading imaging techniques should be restricted. Surgical treatment protocols should be handled conservatively and lesions should be primarily followed-up clinically and by US.
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Affiliation(s)
- Thomas Riebel
- Department of Pediatric Radiology, Charité Centrum 6, CVK, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Mack WJ, Ghatan S. Congenital pterional dermal sinus in an 18-month-old child: case report. Neurosurgery 2007; 61:E661; discussion E661. [PMID: 17881944 DOI: 10.1227/01.neu.0000290921.93588.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Congenital dermal sinus tracts most frequently occur in the midline and are often associated with dermoid or epidermoid inclusion cysts. A lateral cranial origin is extremely rare and anatomically inconsistent with an etiology involving closure of the rostral neural tube during embryogenesis. CLINICAL PRESENTATION We describe the first case of a pterional cranial dermal sinus tract associated with a small epidermoid, with extension to the dura of the anterior cranial fossa. INTERVENTION The extra- and intracranial portions of the tract were visualized and resected with the use of an operating microscope. Pathological diagnosis confirmed dermal sinus tract. CONCLUSION We review the existing literature and address the developmental and clinical features pertinent to the management of cranial dermal sinus tracts, emphasizing the need for exploration of these potentially harmful lesions.
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Affiliation(s)
- William J Mack
- Department of Neurological Surgery, Columbia University, New York, New York 10032, USA
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Abstract
A 9-month-old infant presented with orbital cellulitis and recent discharge from a hair-bearing pit above the eyebrow. Orbital imaging demonstrated a tubular lesion and sinus tract extending from a hypoplastic sphenoid wing, through the lateral orbit, to the skin surface. Complete excision of the dermoid cyst and sinus tract was performed through an eyelid crease approach.
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Affiliation(s)
- Timothy S Wells
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA
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21
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Abstract
Congenital orbitofacial dermoids can be segregated into frontotemporal, orbital, and nasoglabellar regions. Although 10% to 45% of nasoglabellar dermoids present with sinus tracts and occasional intracranial extension, it is rare for frontotemporal dermoids to do so. Frontotemporal dermoids typically manifest as superficial, slow-growing masses that are treated by simple excision. In this retrospective review of 24 patients with congenital orbitofacial dermoids, the authors noted three cases of temporal dermoids with sinus tracts and bony involvement. All three patients were female, with an average presenting age of 4.2 years. Two lesions appeared on the left and one on the right. Each lesion involved the sphenotemporal suture, requiring debridement of the outer cranial table to prevent recurrence. In light of their experience, the authors offer an amendment to the current treatment algorithm for congenital orbitofacial dermoids. A congenital frontotemporal dermoid with a sinus tract should have preoperative radiological evaluation with computed tomography or magnetic resonance imaging to define the pathological anatomy. If bony invasion exists, aggressive exposure and resection of at least the outer cranial table is necessary to prevent recurrence. Temporal dermoids may represent a distinct entity that requires a separation classification from frontotemporal dermoids.
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Affiliation(s)
- Martin Lacey
- Department of Plastic and Hand Surgery, Regions Hospital, Saint Paul, MN 55101, USA
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